Ethics, Bias, and Governance in Artificial Intelligence for Hepatology: Toward Building a Safe and Fair Future

Artificial intelligence (AI) is fundamentally changing how modern medicine is practiced with the intent of advancing and accelerating patient care and improving both patient experience and outcomes. AI, however, has been confronted by several challenges, including but not limited to ethics, regulation, and public trust. This paper explores an approach to AI governance in healthcare, specifically in hepatology. As AI continues to grow, it will be crucial for healthcare providers and our community as hepatologists to understand the implications and impact of this growth and what this means for our practice and patients. We draw from existing AI frameworks, principles of medical ethics, as well as quality healthcare principles to propose our framework for AI in hepatology. Our proposed framework includes patient-centered care, non-maleficence and safety, equity, transparency, accountability, and security and privacy. For each of these topics, we discuss examples relevant to hepatology. We also propose an action plan for hepatologists on how each of these principles can be upheld in our day-to-day practice. While many hepatology specific AI applications are currently being tested in research studies, they have not yet made it to "prime time." As a result, the hepatology community has time to consider governance structures to put in place in preparation for the inherent challenges that come with AI implementation and integration into clinical care to ensure that care is responsible, ethical, safe, and secure. With careful and conscientious planning, the inclusion of relevant stakeholders, and laying the groundwork for governance, AI can improve quality of health care in hepatology with efficiency, improved safety, and equity.